Early menopause and vulvodynia
I first met Robin when she was 44-years-old. She had been suffering for three years with severe vaginal dryness, tightness, burning, and pain with intercourse. These symptoms started after she had her second child. She had tried a bunch of different conventional therapies her regular docs recommended, but nothing had worked, and it looked like she was going into premature ovarian failure – or early menopause – flagged by her FSH levels testing significantly elevated at the age of 42. I also diagnosed her with vulvodynia. Part of how that diagnosis is made is testing the patient’s pain sensitivity on the vulva – even light touch prompts serious pain.
My initial approach was to refer Robin to a pelvic floor therapist. I also started her on compounded estriol to help bring back some moisture to those areas and to help with the burning and pain with intercourse. Because Robin had a lot of environmental and chemical sensitivities, I worked with many compounded pharmacies to try different delivery systems and carrier substance for the estriol, finally unlocking the right solution for her – olive oil! This is the beauty of a compounding pharmacy. They allow practitioners to customize solutions for the individual patient. With 1 mg. estriol in an olive oil base, one capsule at bedtime for two weeks and twice weekly thereafter, Robin’s dryness started to improve although she still suffered with a lot of other sensitives.
As background, Robin presented as underweight, and a hormone panel at 39-years-old showed low estrogens and high FSH. She had had a couple of periods after her last child, but they were infrequent. Her mom went through early menopause; and because she’d had low estrogen for a while, a parent with osteopenia and a few fractures, we needed to screen for bone density.
Initial Tests
· CBC with differential
· Comprehensive metabolic panel
· Lipid panel and Hemoglobin A1c
· Ferritin
· Comprehensive Thyroid: TSH, Free T4, Free T3, Total T4, Total T3, Reverse T3 & TPO Antibodies
· 25-OH Vitamin D
· Vitamin B12
· Folate
· CRP-hs
· Magnesium, RBC
· Sex hormones: Progesterone, Estrone, Estradiol, DHEA-S, Testosterone (Total, Bio and Free)
· Cortisol
I also repeated her earlier hormone tests to validate those results because sometimes a wonky cycle during the test period can throw off a lab.
Follow-up
I worked with Robin on her nutrition and digestion. Our gut is connected to everything! If your body doesn’t have enough pre-cursors, it won’t make it hormones. I also prescribe a course of IV nutrients once a week for 12 weeks. She responded very well and put on a little weight. Women also need to understand that no matter if they are underweight, stable weight or overweight, they need healthy fats in order to keep hormones healthy (and the brain healthy!)
She also started pelvic floor therapy after she had been on estriol for a while so her tissue was plumper and wouldn’t bother her.
Lifestyle
Because Robin was under quite a lot of stress, we focused on self-care: 15 minutes/day for journaling, meditating, short walks or gentle yoga. I urged her to prioritize getting enough sleep now that her kids sleep better. She also worked with some light free weights at home to support stronger muscles which lead to stronger bones.
As far as nutrition, I emphasized increasing water intake and lean proteins to grow lean muscle mass. Her digestion doesn’t tolerate raw veggies so I suggested bone broth (there are some great concentrates you can buy if you don’t want to make your own) and lightly steamed veggies which protect her gut while maintaining nutrients.
I added in a supplement for HPA Axis support which contains a multitude of adrenal adaptogenics – great for stress and energy stability throughout the day.
Three-month follow-up
After this comprehensive work, we repeated Robin’s labs. While her FSH improved, her estrogen was still low, and she was still having symptoms. I decided to put her on an estradiol/progesterone combi patch. I also prescribed a vaginal and urine tests to try and get to the bottom of her frequent bladder infections and to see if there was a link with her other digestive and vaginal symptoms. We used Microgen, a PCR test, finding that she didn’t have enough good bacteria in her vagina to protect against infections. This happens for a variety of reasons – frequent antibiotic use (often prescribed for UTI’s, plunging women into a never-ending cycle of infection / drug intervention.) In addition, if you don’t have enough estrogen, it can impact your good bacteria. We re-estrogenized the vagina and used a probiotic suppository in the morning, dropping down to a couple of times a week after about 6 weeks.
Cost
Office visit: Naturopathic doctor fees can range but our practice, Shalva Clinic in Westport, CT & NYC, charges $550 for a 90-minute visit; first follow-up visit (1 hour) is $400; and any other follow-up visit (½ hour) is $200.
Labs: Cost depends on healthcare coverage/plan; self-pay panels can range from $200-350 for blood tests.
Prescriptions: Compounded prescriptions range between $30-100.
Lifestyle: We always try to recommend the easiest and low-cost solutions! Walking for exercise is free; YouTube exercise videos (try Move with Nicole for pilates or POPSUGAR Fitness.) The Peloton app for phone or iPad (no bike required!), is just $12.99/month for unlimited yoga, walking, running, weight workouts and more. Also, you don’t need anything to meditate – just find a quiet space, close your eyes and breathe in and out. But, if you’d like some guided help, search Spotify or YouTube for great options.